Better Ways to Pay for Health Care
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Payers for health care are pursuing a variety of policies as part of broader efforts to improve the quality and efficiency of care. Payment reform is but one policy tool to improve health system performance that requires supportive measures in place such as policies with well-developed stakeholder involvement, information on quality, clear criteria for tariff setting, and embedding evaluation as part of the policy process. Countries should not, however, underestimate the significant data challenges when looking at price setting processes. Data access and ways to overcome its fragmentation require well-developed infrastructures. Policy efforts highlight a trend towards aligning payer and provider incentives by using evidence-based clinical guidelines and outcomes to inform price setting. There are signs of increasing policy focus on outcomes to inform price setting. These efforts could bring about system-wide effects of using evidence along with a patient-centred focus to improve health care delivery and performance in the long-run.
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Bundled health care provider payments
“Bundled” payments for health care, where several services relevant to a condition or intervention are grouped together for payment, are being used in several OECD countries. Bundled payments go beyond DRG payments, and aim to encourage cost savings and quality improvements for acute episodes of care such as elective surgical interventions and care for chronic conditions such as diabetes.
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